Phosphodiesterase 5 (PDE5) inhibitors are a type of drug that can affect blood flow and how cells communicate in the body. PDE5 inhibitors can also appear in some foods and supplements.
People may take PDE5 inhibitors to manage conditions such as erectile dysfunction (ED) or pulmonary hypertension.
In this article, we explain how PDE5 inhibitors work and the potential risks and side effects of taking them. We also provide a list of drugs and substances that contain them.
Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.
Medical News Today follows a strict product selection and vetting process. Learn more here.
PDE5 is an enzyme in the walls of blood vessels. It affects blood flow and how cells signal within the body.
PDE5 inhibitors block the PDE5 enzyme to prevent it from working. This inhibition relaxes the blood vessels and increases blood flow.
People may take PDE5 inhibitors to treat ED or pulmonary hypertension.
In people with ED, PDE5 inhibitors increase blood flow to the penis, improving erectile function.
In people with pulmonary hypertension, PDE5 inhibitors can help by:
- controlling blood flow to the arteries in the lungs
- increasing blood flow to the lungs
- lowering blood pressure
Current research looks into whether PDE5 inhibitors are also effective in treating cognitive disorders like dementia.
Various PDE5 inhibitor drugs are available, and people usually take them in tablet form.
In the United States, the following prescription PDE5 inhibitors are available:
Avanafil (Stendra)
Avanafil, brand name Stendra, is a relatively new ED medication. An older study reports that this drug takes effect quicker than other ED treatments, taking effect around 15 minutes after ingestion, and does not last as long, with a maximum duration of
Additionally, a
Vardenafil (Levitra)
Vardenafil, brand name Levitra, achieves maximum effect around
Tadalafil (Cialis, Adcirca)
Tadalafil, which has the brand names Cialis and Adcirca, has the slowest onset of ED medications, achieving maximal effect around
Sildenafil (Viagra)
Sildenafil, brand name Viagra, takes effect around 60 minutes after ingestion. It lasts for
People can only receive ED medication through prescription. A healthcare professional must write a valid prescription that a pharmacy must fill.
Learn more about how and where to purchase specific ED medication here:
However, several telemedicine companies offer prescription ED medications. Some companies also offer online doctor appointments to receive prescriptions if a person does not already have one.
Options include:
Hims is a telehealth company specializing in male health conditions, including erectile dysfunction.
This company offers sildenafil (Viagra), tadalafil (Cialis), and avanafil (Stendra). It also offers online appointments with healthcare professionals.
Price: The cost of ED medication starts from $3 per dose.
Roman is a telehealth company also specializing in male health conditions, including treatment for ED.
It offers sildenafil (Viagra) and tadalafil (Cialis). Similar to Hims, Roman also offers online appointments with healthcare professionals.
Price: The cost of ED medication starts from $2 per dose.
There are also several other substances and supplements that are PDE5 inhibitors. However, a person should not take any supplements that claim to treat ED without first seeking the advice of a healthcare professional.
The
Phentolamine (Regitine)
Phentolamine (Regitine) is a prescription medication for hypertension.
However, healthcare professionals
Individuals should contact a doctor and discuss whether phentolamine is the right medication for their circumstances.
L-arginine
L-arginine is a type of amino acid available in many foods.
A
Yohimbine (Yocon)
Yohimbine is a compound in a tree native to central and western Africa. Traditional medicine uses the bark to increase sexual arousal and performance.
The
Due to safety concerns, several countries have banned yohimbine.
Black ginger
Black ginger, or kaempferia parviflora, may have a slight PDE5 inhibiting effect.
A small
Tongkat ali
Eurycoma Longifolia, or tongkat ali, is a plant native to Indonesia and Malaysia.
There is some evidence that Tongkat ali may increase testosterone levels and arousal, which may help improve ED.
Tribulus terrestris
According to a
There is
Horny goat weed
Horny goat weed contains icariin, an extract from the Epimedium plant.
An
The following table compares the PDE5 inhibitors in this article.
| FDA approval for ED | FDA regulation | Prescription or over the counter | |
|---|---|---|---|
| Avanafil | yes | yes | prescription |
| Vardenafil | yes | yes | prescription |
| Tadalafil | yes | yes | prescription |
| Sildenafil | yes | yes | prescription |
| Phentolamine | no | yes | prescription |
| L-arginine | no | no | over the counter |
| Yohimbine | no | no | over the counter, banned in some countries |
| Black ginger | no | no | over the counter |
| Tongkat ali | no | no | over the counter |
| Tribulus terrestris | no | no | over the counter |
| Horny goat weed | no | no | over the counter |
People who are taking nitrate medication should avoid taking PDE5 inhibitors. The combination of both medications can cause a severe decrease in blood pressure, which can potentially be fatal.
People may be taking nitrate medications for chest or heart issues. These drugs include:
- nitroglycerin (Nitrostat)
- isosorbide dinitrate (Dilatrate-SR, Isordil) or isosorbide mononitrate (Imdur, Monoket)
- amyl nitrate, or “poppers”
PDE5 inhibitors can also potentially be harmful to people with
- have a history of heart attack, severe arrhythmia, or stroke in the last 6 months
- have hypotension or hypertension
- have a history of heart failure or angina
- are currently using alpha-blockers
Common, and usually mild, side effects of PDE5 inhibitors can include:
- headaches
- flushing
- symptoms resembling those of the common cold
- stomach upset
- muscle and back pain
Rare side effects may include:
- changes in vision, or sudden loss of vision, for which people with heart disease or diabetes are more at risk
- sudden loss of hearing
- prolonged or painful erections that will require treatment to prevent lasting damage
PPDE5 inhibitors may interact negatively with grapefruit juice and alcohol. They can potentially also interact with other medications, so people should make their doctor aware if they are taking other drugs or supplements.
Some herbs contain PDE5 inhibitors, so people may find them in certain supplements or herbal remedies.
However, herbs and supplements
The
It is advisable to speak to a doctor before taking substances and supplements that contain PDE5 inhibitors or promise results equivalent to those of PDE5 inhibitor prescription drugs.
A person may wish to contact a doctor if they are finding it difficult to have and maintain an erection.
Doctors may ask questions about a person’s sexual history,
- the frequency and length they have erections for
- whether any factors make it harder to have an erection, such as stress
- how often the person has sex
- whether the person is already trying treatments
- if the person has a partner, whether they would be willing to be involved with treatment
Healthcare professionals may also ask questions about certain risk factors, such as whether a person has type 2 diabetes or high blood pressure. They may also ask if the person smokes, drinks, uses drugs, or does regular activities.
These questions help doctors determine the best treatment option for each person. They may recommend prescription medication, such as sildenafil, to help people maintain their erection for longer.
Here we answer some common questions.
Can you mix caffeine and Viagra?
Currently, there are no known interactions between caffeine and Viagra or sildenafil.
However, people may wish to contact their doctor or another healthcare professional for advice if they intend to have beverages with high caffeine content alongside PDE5 inhibitors.
What everyday foods contain PDE5 inhibitors?
There are several supplements containing ingredients that may act as PDE5 inhibitors. These include horny goat weed and black ginger.
Scientists
A small
However, the
PDE5 inhibitors block PDE5, an enzyme in the walls of blood vessels. Blocking PDE5 causes blood vessels to relax, increasing blood flow to certain areas of the body.
This effect means that they can help manage conditions such as ED and pulmonary hypertension.
People taking nitrate medication should not take PDE5 inhibitors because the combination of drugs can cause a dangerous drop in blood pressure, which can be life-threatening.
Other drugs, foods, supplements, or herbal remedies may contain PDE5 inhibitors. These may not have FDA regulations and could contain unlisted ingredients or contaminants, or interact with other medications.
People should discuss any potential side effects or drug interactions of PDE5 inhibitors with their doctor before taking these medications.